Clinical characteristics, management and predictors of mortality: results from national prospective cardiogenic shock registry (CZECH-SHOCK).

Abstract

Background: Only limited epidemiological data exist from national or international prospective multicentre registries covering the whole spectrum of cardiogenic shock (CS) aetiologies.

Methods: CZECH-SHOCK was a national prospective multicentre observational study conducted in 15 main tertiary care centres in Czechia over a 12-month period from March 2023 to February 2024.

Results: A total of 418 patients with a median age of 70 (IQR 59-76) years were enrolled. The majority of patients were male (69.6%). A newly developed heart failure was observed in 76.8% patients, and acute myocardial infarction complicated by CS (AMI-CS) was the most frequent cause of a CS episode (56.7%). Mechanical circulatory support devices were utilised in 28.2% of cases. A 30-day mortality was 39.5%. In a multivariate analysis, six independent factors were associated with a higher 30-day mortality: age (OR per 10 year increase: 1.78, 95% CI: 1.45-2.19), history of coronary artery disease (OR: 2.38, 95% CI: 1.41-4.30), history of chronic obstructive pulmonary disease (OR: 2.58, 95% CI: 1.27-5.25), SCAI class on admission (OR per one class increase: 1.64, 95% CI: 1.27-2.11), renal replacement therapy during in-hospital stay (OR: 2.46, 95% CI: 1.32-4.59) and new mechanical ventilation after admission (OR: 4.58, 95% CI: 2.50-8.39).

Conclusions: AMI-CS still represents the most frequent cause of CS episodes. The in-hospital mortality of patients with CS remains high, despite frequent utilization of hemodynamic support and organ replacement therapies.